Action Plan for Diabetes Care and Management

Action Plan for Diabetes Care and Management Template for Action plan for Case Study – MM What is the goal/aspect of diabetes care/management patient would like you to help them with? MM does not want to go onto to Insulin therapy as she’s heard bad stories of insulin and losing limbs. She is willing to try anything else to see if it controls her diabetes. She feels a lot of her negative aspects in her life have been addressed she is working through them and she wants to lose weight and try to get her diabetes under control What action (s) will the patient take and when? The patient will currently try and relook at her eating habits in relation to her diet. She is considering batch cooking, portion meals and freezing them. She saw a leaflet in the waiting room about healthy helpings and asked if I knew anything about it. Advise her it was a group session meeting over 8 weeks looking at healthy eating, lifestyle and ways to put it into practice. It was also occurred no cost so she indicated she would look into this and let me know the next time we met. She will look at ways to increase exercise. We discussed this in more detail activities like swimming would take pressure off feet – she never learnt to swim. I gave her a leaflet for her to make contact with technogym in the area. A form of exercise with different equipment whilst body is mostly sitting on a machine similar to exercise club called Curves. She also indicated she was happy to consider more medication to control her diabetes and so to reduce her HbA1c and hopefully her weight. When will the action take place? The pt was away to go on holiday so not appropriate to implement any new medication change until she returns. She advised me she would keep an eye on what she ate while away and try to keep as active as possible till she returned to see me. On a confidence rating of 0-10 how confident is the patient of achieving their goal? (0=not confident 10 =very confident) 7 – she does want to change and move on with her life. She wants to be able to play more with her grandchildren. Who/what will help them achieve this goal? If MM can see and feel the changes she is about to undertake this will her motivated to keep going. Her Grandchildren are at the active phase and want her to join in with them – she also wants to join them and have fun. Support from her family as they want her to be more an active role member for the grandchildren. Who /what may stop them achieving this goal? Patient falls back to her old ways. If the family due to their busy lives overlook her and she feels she hasn’t got the support, if she doesn’t have weight loss this will deflate her confidence in achieving the goals. If she is not able to exercise because the planter fasciitis reoccurs this will disengage her motivation and could affect her diabetic control. As their healthcare professional what is your role? To provide ongoing support so to help the patient loose weight and try and bring her HbA1c back in line. Continue to be up to date with the information I give her in relation to external support to the diabetic clinic for example healthy helpings. Be able to discuss this with the patient so she is able to make an informed choice. Work along with the patient in the treatment options available to her. Be able to explain how the medication works to try and improve glycaemic control address the medication side effects and any other requirements she may have to perform with appropriate medication choices. I will work along with the patient so to enhance good rapport in order to alleviate any fears together try and achieve the required goals. Review Date 3 weeks Rationale for intervention(s) Nice (2009) guidelines when to consider medication options for diabetic control. Diet measures/ exercise education reinforced each time, essential part in the diabetic management. Triple therapy GLP1agonist receptor improves gylcaemic control. Works well with metformin and SU. MM’s BMI was greater than 35Kg. Its action to stimulate insulin secretion and delay gastric emptying therefore appetite reduction and weight loss. 59 Brief outline the intervention(s) considered with the patient and the evidence base supporting this intervention(s) provide references when appropriate Waddington (2011) like others comments on the weight battle in relation to diabetes suggesting to improve patients confidence in weight loss patients have to play a active role in the decision making process. Importance of getting this right is huge the current cost of obesity alone to the NHS estimated at 1 billion/ year Diley (2008) The ever growing problem which was made a priority by the DOH in 2004 is now a serious concern of the UK. That was 10 years ago how true was there prediction. It’s reckoned to surpass smoking as biggest cause of premature loss of life Diley (2008). Our aim to try and achieve weight loss Haslam (2005) goes onto to highlight this as a mainstream treatment. If there is a 10% reduction it improves diabetes control all round. Waddington (2013) compares the commercial weight industry organisations, similarly examining energy input versus output combined with exercise the aim – weight loss. Not a quick fix nor easy and can be very misleading. MM hereby commencing a free healthy dietary course similar to this via the NHS non biased. MM’s exercise limited but aware of the government’s recommendation of 30 minutes of exercise a day. Robertson (2009) and Mayor (2012) comment 70% of the population don’t do enough exercise yet a cornerstone of diabetes management. It in- expensive method use a pedometer to achieved 10,000 steps a day provides a visual encouragement tool Waddington (2009). Nice (2009) looked at randomised controlled studies and found that GLP-1 had a greater effect in reducing glycaemic control and weight loss over DPP4 or insulin. 265 Reflection of the consultation What? Description of the event Recent review with MM increased HbA1c readings a number of reasons. MM wants help to control her diabetes better and loose weight. Diet and Exercise discussed which treatment options. Liaglutide chosen as once daily injection. Prescription given to patient and return. Self home monitoring of blood sugars Reinforced due to increased risk of hypo with this additional treatment. So What? Analysis of the event Outside agencies discussed to assist with diet and exercise measures. Open discussion of treatment options MM decided to go with GLP-1 receptor agonist, Liraglutide was decided as good HbA1c reduction and weight loss and more suited for MM. Reiterated to patient the recommendation on the use of GLP1 for diabetic treatment. A requirement of HbA1c reduction by 1%, weight reduction by 3% in 6 months if not met then to remove treatment choice is advised by Nice (2009) Now What? Proposed action following the event Teach MM administration of liraglutide injection, site rotation, disposal of products, and storage of medication. Guidance liraglutides initial dose 0.6mgs to max 1.2 mgs. Greater risk of hypo’s due to additional therapy additional Blood sugar readings required monitor to be check set properly working. 194 References HARVARD DILEY A. (2008). HELPING PATIENTS TO LOSE WEIGHT: BEST PRACTICE FOR PRIMARY CARE. primary care nursing. 5 (1), 31-34 HASLAM D. (2005). THE IMPORTANCE OF MANAGING INSULIN RESISTANCE AND WEIGHT. Independent Nurse. 16-17 NICE GUIDELINES (2009)The Management of Type 2 Diabetes www.nice.org MAYOR S. (2012).PHYSICAL ACTIVITY : GETTING PEOPLE MOVING TO PREVENT CVD. primary care nursing. 9 (2), 59 61 ROBERTSON C. (2009). WALKING YOUR WAY TO GOOD HEALTH. primary care nursing. 6 (1), 33-35 WADDINGHAM F. (2013). WEIGHT LOSS: WHICH METHODS REALLY WORK FOR PATIENTS?. primary care nursing. 10 (2), 59-62 WADDINGHAM S. (2009). HELPING PATIENTS WITH DIABETES TO WIN THE BATTLE TO CONTROL THEIR WEIGHT. primary care nursing. 6 (3), 115-117 WADDINGHAM S. (2011). NINE PROCESSES OF CARE FOR DIABETES. primary care nursing. 8 (4), 170- 173 Detailed case study 2 Consultation Review 1 MM Review Date 30/09/2013 Patient seen 08/09/2013 (3 weeks ago) What was the intervention Commencement of Liraglutide injections 0.6mgs for the next week and increased home blood sugar readings Patients assessment of intervention MM felt it was daunting at 1st at the thought of giving herself an injection. She was pleased that she managed to self administer her injections and thought it was that bad after all. We discussed aspects that we previously discussed before starting the treatment. She found she forgot to rotate injection sites, but remembered by the end of the week. She undertook regular blood sugar readings and they were starting to show 5 mmol/lit before bed and on waken 10mmol/lit. No side effects noted and patient dose of liraglutide was increased to 1.2mgs. Reflection of the consultation What? Description of the event A review on how the patient felt with her new choice of treatment and to assess if there were any problems experienced either the injection site, or increase in hypoglycaemia So What? Analysis of event On assessment MM was coping well with injecting liraglutide, no side effects were experienced. Increase dose of liraglutide to 1.2 mgs and reassess how effective treatment was in relation to the measurements of home blood monitoring. Reminded her to be aware of possible increase in hypoglycaemia to continue performing measurements as she had done previously. What now?Propsed action following the event Next review appointment was made for 1month asked her to bring in her blood sugar readings to assess effectiveness of treatment and no signs of hypoglycaemia. Also advised if there were any problems for her to telephone and ensured she had a note of the number. 130 Consultation Review 2 Detailed Case Study 2 MM Review Date 30/10/2013 Patient seen 30/09/2013 (4 weeks ago) What was the intervention Increased dose of liraglutide to 1.2mgs daily Patient’s assessment of intervention MM was feeling good within her. She had noticed a reduction in her blood sugar reading they were down and ranged between 5-7 mmol/lit for fasting levels and range 6-8 mmol/lit for day time. She had done well with site rotation. Experienced no hypo’s and generally felt well. Has reduced appetite and aware there has been some with loss. Along with the medication change she has completed healthy helpings programme and now actively addressed exercise regime and working towards achieving her 10,000 steps not managing that every day as yet. Reflection of the consultation What? Description of the event A review of MM’s progress of new medication choice. She is now taking maximum dose of Liraglutadie of 1.2 mgs daily. No adverse effects had been experienced by patient in relation to side effects or hypo’s. She showed good evidence of regular monitoring. She herself was more upbeat, more positive in terms of her diet, new exercise regime and new 3rd line therapy that was commenced. So What? Analysis of event Encouraged to see patient doing so well not experiencing hypo’s this is a particular area to be vigilant as she was already on a SU. If hypo’s were experienced then SU would be reduced and regular monitoring continued till blood sugar readings were stable and no hypo’s were experienced. A reduction in home blood sugar readings and wt loss of 2 kgs were noted. MM praised for efforts so far. What now? Proposed action following the event To continue with current treatment regime, to be vigilant of possible hypo’s to cont with regular monitoring or at any time she didn’t feel right. Telephone me if any concerns. Continue with her good diet and exercise regime. To return to practice for repeat HbA1c and weigh in 2 months to see how treatment choice was going. 193

My Trip To The Dominican Republic :: essays research papers

My trip to the Dominica n Republic I was to leave to the Dominican Republic at 10p.m. on a Thursday night. My flight was with Tower Air and it was leaving John F. Kennedy airport. I had to be there three hours before departure and I was I was there at 7p.m. It felt like they longest wait of my life. At 9:30p.m,they announced that we would not be leaving on time because the plane had technical difficulties. Our flight would now leave at 12p.m. I couldn’t believe this was happening to me. It was a nightmare. They had already changed my flight like five times before. I was leaving one day, then I was leaving the next and so on. Then they wait for the last minute and the food shop had closed, so there is about a good 200 or so people without food and all upset cursing up a storm. To top it all off, half of the people there were teenagers going to the Dominican Republic to play baseball. Can you imagine? A hundred something kids hungry and sleepy screaming their lungs out. However, the nightmare wasn’t over. They got us on the plane at about 2a.m because the plane wasn’t ready. I couldn’t get on the plane because I kept buzzing when I passed the medal detectors, so that took another 20 minutes. Then we are on the plane and the plane isn’t moving, and we are waiting and waiting and no explanation. After a while the plane begins to move. It when around the run way and then they tell us we must get of the plane. It needed more service repairs. At this point I’m like give me my money back, and in return they call the cops because we were making to much noise. They fix the problem around 5:30a.m and we are off again. Keep in mind we haven’t eaten and no food was given. I didn’t even get water. I thought this was a sign of god and my time had come for me to die, but I made it there in one piece. At our arrival the planes door wouldn’t open and they said we might have to return to New York. I couldn’t believe this. I was ready to jump out a window. Finally we are let out of the plane and I had to wait like three hours for my grandfather to come pick me up.

Heaven Can Wait Belt Up

Commercial analysis: Heaven can wait belt up This report will discuss the issue commercial how to convey the idea to consumer. Introduction Here is a car charity commercial advertisement without any world and talk through. Only utility the background music, shocking animation and a woman sang. It brought us the shocking and stunning. At last, the image fade out, then show the slogan â€Å"heaven can wait belt up†. As the following we will talk about the commercial advertisement. Here is one of places in the world, and everything is just like normal. For a while, the clash burst out, and tree is shaking.Furthermore, we saw a car bump into a tree strongly. There are three persons on the car. All of them are unconscious. Few seconds later, their soul was department from their own body. The three people, only one of them belt, and others doesn’t. Because of the driver didn’t belt, their souls went up to heaven, so as the backside passage. But the front passenger had belt, his soul was struggle for the belt. But the belt restricted him to get rid of. At last, the belt rescues the front passenger. After that, the screen show the slogan, †HEAVEN CAN WAIT BELT UP† and fade out.This charity alarm us should seat belt when we drive, no matter you are driver or passenger. Belt can keep u safe, even heaven can wait belt up. Next, we will discuss the characteristic, animation and music. Characteristic There are only three persons in the video, the driver, front passenger, and back passenger. Besides, here are car, tree, soul and music. The animation of soul showed us a strongly visual effect. Moreover, with the music, we can feel from peace to shock. In the whole advertising, there is without any words in the video. Music All of the advertisement without any word and talk through.There are only the music and the image in the advertisement. But it strongly remained us we should belt when we drive no matter we are driver or passenger. So the mu sic here is important and indispensable, and we will discuss about the transition of the music. There are three sounds of the different types. First is peace situation with the sound of bird and nature. Then when the clash occurred, the condition was changing. At last is the song which woman song amazing music. At beginning, the surround is bird’s song and the nature’s voice. It means everything is peace and we don’t need to worry about anything.When clash burst out, everything changed. Soul of life wants to leave their body, and the women’s voice stand for life will go to heaven. Just like god summon and they must to leave. But when the women’s voice disappeared, the soul of that front passenger back with wheeze and heavy breathing, seems the life returned. Then the nature’s voice returned, and everything is back to the normal peace. In the west-country, when we die we believe we will go to heaven and get rid of the guilty, and the song wit h the women’s voice stand for the meaning of go to heaven. The sound from beginning to the end was a continuous situation.We can image the situation with the music and the animation. It shocked us the feel of visual and sound. Without any word, but tell us the safety method to drive. Animation The soul spilt from the body, they struggle but only one back to their own body. The soul means our life is weak and we need to protect by the belt. Youth are often hasty and without thinking. So the soul is just like our original nature. But the belt protect the soul get away from the passenger, so it is simply to tell us we should belt up and then we can drive. Customer analysis We will discuss that by sender and receiver’s viewpoint. SenderHere is a car commercial charity advertising which is sponsored by Axion. It is a bank company always support youth’s activities from Belgium and their focus market is youth group. So the advertisement is also made to the youth who sh ould belt up when they drive. There are two different meanings in that advertisement. One of that reminded drives or passenger who should belt up, keep your life safe. And another one is keeping your money in a safe bank account. So youth can notice that car accident without belt is closed to youth’s life. For youth, they are potential group for bank. There are some reasons we can talk about.First of all, youth are going to step into the employ market sooner, and most of them don’t know how to deal with their dollar. The second is youth don’t have enough knowledge for finance, such as we don’t know how to loan form bank and so on. Most important of all, we are too young to do the reasonable thing. Everything is fun, we must try. So the dangerous will happen when we think it’s cool. In short, if the bank can provide us a safe account to keep our dollar and we can utility money in proper method with less risk. So the other meaning is that ad is †Å"choice our bank we will provide you a safe account and protect you from the crisis†.Their niche market focus on the youth group, this group drive fast and doesn’t know how to evaluate the risk. When the disaster occurred, they can’t handle with that situation. So Axion can provide you a good solution to prevent the problem. If you go to our bank and apply our service, we will give you a safe insurance for your account. Furthermore, you also can have a loan in our bank. All in all, the sender gave us two messages. One is when you drive, you should belt up. And another one is our bank can give you a better choice. Receiver Axion is focus on the youth group, who can drive.The economic situation is in the middle of class, and the range of age is around 16 to 35. If you have the right to drive, you are the receiver. Besides, education level can range from senior high to adult and gender is focus on male. At last, we will show the video to youth who can drive and the ir age are around 20 to 30 then get the feedback from them. The feel of people who see the advertisement We showed this video to youth, and ask them two questions in order to get the feedback of video. First, what’s your first impress about the video? And can you image the situation you drive in the future?In the first question, the answer is interesting such as the belt’s effect is like magic, supplemental restraint system didn’t work, even one of them feel creepy, and the road is big but why they still can bump the tree. And the second is consistent. Because all of them said â€Å"we need to belt up†. Conclude To sum up, the video want to tell us, â€Å"HEAVEAN CAN WAIT BELT UP†. When we drive, we need to belt and that can keep us safe. It’s important for us to belt when we drive. And the other point is if youth want to choose a bank, you can find Axion’s bank. Related article: Conveyor Belt Project

Research Paper - Is Christopher Columbus a Hero or Villain

Christopher Columbus found a new world and jumpstarted an age of exploration like no other. After he found the Americas there was massive colonization, giant trade increases and more resources such as gold and silver were being surfaced. Europeans learned new agricultural techniques from the indigenous people, the Europeans also acquired a large number of new crops to farm such as potatoes, tomatoes, corn and cocoa. With all of the pros that the age of exploration brought to Europeans it is hard for one to imagine that Christopher Columbus could be a villain. Could there possibly be evil behind some of the wonderful discoveries of Christopher Columbus? The problem is exactly what you just read, people only know the good things†¦show more content†¦The reason why the Native Americans were hit so hard by this disease was because their immune systems were not strong enough to protect their bodies from contracting these diseases. When the Europeans landed they brought dise ases with them that were completely foreign to the Native Americans immune systems and they were not ready to deal with all of the European diseases and as a result the Native Americans acquired these diseases that they could not prevent or cure. Christopher Columbus does not judge people upon their skill or personality, Christopher Columbus chooses to judge people based upon whether he likes them or not. Christopher Columbus chose to hire his brothers to look over his settlements while he was away exploring other lands. His brothers were unqualified and were incapable of managing a settlement. Anarchy rose in their colony and the three Columbus brothers were arrested and were sent to jail in Spain. The people you know best in this world are your brothers and if you have the slightest suspicion that they cannot handle the responsibility of managing a colony then somebody other than your should be chosen to lead a colony. Leading a colony in a new world is a huge responsibility and Christopher Columbus trusted his two incompetent brothers with that huge responsibility. When Christopher Columbus choseShow MoreRelatedMarketing Mistakes and Successes175322 Words   |  702 PagesDeCandia Alana Filipovich Jeof Vita Arthur Medina Allison Morris This book was set in 10/12 New Caledonia by Aptara ®, Inc. and printed and bound by Courier/Westford. The cover was printed by Courier/Westford. This book is printed on acid-free paper. Copyright  © 2009, 2006, 2004, 2001, 1998, 1995, 1992, 1989, 1986, 1981, 1976 John Wiley Sons, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronicRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesOrganizational Behavior This page intentionally left blank Organizational Behavior EDITION 15 Stephen P. Robbins —San Diego State University Timothy A. Judge —University of Notre Dame i3iEi35Bj! Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Editorial Director: Sally Yagan Director of Editorial Services: